OPHTE# 17 -5� �a � Harnett County Department of Public Health 25033
PERMIT # Q `1-7a'�) Operation Permit
1K New Installation '�k Septic Tank Ar Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: O"o Q%WQ
Name: (owner) Go'c" 20 45o.. i-1ymb5 SUBDIVISION LOT #
System Installer: SEe7 - c Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms L_
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: U Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
QLO OgAlr19¢6 F—NZ1St,\r—j --,
PERMIT
I. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required.? Yes ❑ No,K
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D•Box
❑ Pump ❑ Alorm ❑
H2O1-ine ❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above captioned grope
GHhMgEJL
Type of system:
El Conventional
Other PS1C-36 `AJ Septic Tank: 1000
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
dit es
1 of each ditch feet ditches 1
feet ditches II inches
French Drain Reauired:
Linear feet
Authorized State Agenty ���sn�5 Date
� P F
'
y �
\
s
l-1-5- L-)).3AL�